Revolution in Hospital Management

Revolution in Hospital Management

In a study published in the May/June 2005 issue of the Journal of Healthcare Management, John Griffith, professor of health management and policy and director of the Griffith Leadership Center, and coauthor Kenneth White, director of the graduate program in health administration at Virginia Commonwealth University, examined three recent winners of the Baldridge National Quality Award in Healthcare and concluded that these institutions’ achievements “set a new standard for performance accountability and excellence that we believe is a revolution in hospital management.” All of this prompted us to ask Professor Griffith just what he and White mean by a “revolution,” and what it portends.

Findings: What does a hospital have to do to win a Baldridge Award?

John Griffith: There are seven categories of criteria. The most important one is outcomes, and the other six are the processes that drive the outcomes: leadership, strategies, customers, infor mation, operations, and logistics. To win the Baldridge you have to first describe how you do all those six tasks, and then you have to describe how you measure your performance, and then you have to describe how your results are good, and finally you have to describe how you’ve improved each of those six processes. The concept is one that’s some times called double-loop learning: I can make this widget, and I can improve the process I use to make widgets. That’s the first loop of the learning. Second loop is I’m going to study the processes by which I improve the widget-making and get them better, too.

Findings: So even though it’s already good, you’re constantly striving to make it better?

Griffith: That’s right.

Findings: And hospitals didn’t do this before? Why?

Griffith: For one reason there was a big argument over how you measure quality. For another reason, hospitals were slow to adopt a movement that preceded the Baldridges, called continuous improvement. And the third reason is that to solve the complex problems of doing heart surgery, or delivering babies, or managing an old person with diabetes and cardiovascular problems and arthritis and two or three other things, the classic solution was of domains. So you’d say, OK, that’s the nurses’ domain, that’s the doctors’ domain, that’s the trustees’ domain, that’s the executives’ domain—and within the domain, the domain manager was king. And if you think about that model a little bit you realize that if you’ve got five kings sitting around the table, nothing’s going to happen. It was impolite for one king to say to another king, “Hey, you know, I could buy what you sell down the street for half the price and twice the quality.” Under the continuous improvement model, you can say that.

Findings: What do you see as the biggest advantage to this revolution in management?

Griffith: The biggest advantage is that it improves outcomes. These places are generally in the best quartile in terms of the quality of outcomes. These are places that typically do not have nursing shortages. These are places that people want to work at. From the point of view of the patient, they’re safer, friendlier, more comfortable. From the point of view of the health insurance buyer, the employer, they’re more economically priced, and they cure workers faster. From the point of view of the workers and doctors, they’re fun places to work.

Findings: Are you excited about the future?

Griffith: For years and years and years, the management of hospitals has been something of an art, and this step essentially says it’s no longer an art, it’s now a science or a technology. You ask me how to get a certain part of the job done, and I can find you a best practice to do it, and if you put that best practice in it will work, and it’ll work a lot better than what you used to be doing. That’s exciting.

Send correspondence about this or any Findings article to the editor at sph.findings@umich.edu. You will be contacted if your letter is considered for publication.

Web Exclusive Update:

John Griffith and co-author Kenneth White are winners of the Hayhow Award for 2005 from the American College of Healthcare Executives (ACHE) for their article "The Revolution in Hospital Management," which appeared in the May/June 2005 Journal of Healthcare Management. ACHE grants the Edgar C. Hayhow Award annually to the author(s) of an article judged the best from among those published in the Journal of Healthcare Management, ACHE's official journal. Griffith has received the Hayhow award an unprecedented three times, previously in 2003 and 1989. More info:

"If you've got five kings sitting around the table, nothing's going to happen," says John Griffith, the Andrew Pattullo Collegiate Professor in the Department of Health Management and Policy.

The Griffith Leadership Center was dedicated on October 6, 2005.